In recent years the conversation around racial inequality has focused on law enforcement, but the Department of Population Health’s second annual conference, Health And…Racial Equity and Urban Well-Being, on May 22, brought a different frame to the issue, focusing on what other sectors, like health, housing, and the media can do to reduce the impact of historic race-based policies on health and well-being.

“Our question is how do we in the fields of medicine, healthcare, and public health work to blunt the impact of racism in health, to advance racial equity, to blunt racism, and to build toward neighborhoods that better foster health,” said Marc Gourevitch, MD, MPH, chair of the Department of Population Health, in introductory remarks. The goal is “not so much to explore whether there are connections between racism and health or neighborhood and health but rather to think about strategies to foster and accelerate change.”

Health through a ‘race equity’ lens, from redlining to Zika

In a keynote, Commissioner of New York City’s Department of Health and Mental Hygiene Mary Bassett, MD, MPH, spoke of her commitment to dismantling “structural racism” and its impact on health. Using a “race equity lens” to “uncover problems that we might not have uncovered if we just looked at the aggregate numbers,” the Department of Health is coming up with a “robust set of interventions” to tackle health gaps related to race and income in the city, Commissioner Bassett said.

She cited the Department’s effort to inject resources into predominantly black and Hispanic neighborhoods that were historically impacted by “redlining,” a government practice that effectively denied residents mortgages. In some of these neighborhoods—East Harlem, Tremont in the Bronx, and Brownsville in Brooklyn”—the Department of Health recently opened “neighborhood health action centers,” turning what was largely back office space into primary care and mental health services, community organizations, and health and other city agencies under one roof.

The Department of Health also found lower-income neighborhoods where residents traveled more frequently to the Caribbean had a lower rate of Zika testing than lower risk, wealthier areas of New York City and worked with the city’s public hospital system to close this gap.

“I want to point out how important it is that the research community take up these issues,” Commissioner Basset concluded. “These are not polemical. This is about science and we need better science, more science, to support the kind of work we do in the community.”

A health approach to race-based violence

Speakers on the morning panel, “Addressing the Health Impact of Racism and Violence” presented a diverse set of strategies healthcare and public health can play in working to reduce discriminatory violence.

Joseph Ravenell, MD, MS, associate dean for diversity affairs at NYU School of Medicine, shared an approach for doctors to counsel their black patients on how to stay safe during law enforcement encounters, which he first published in a 2016 op-ed in the New York Daily News called “Doctors’ Duty to Black Men” with former Department of Population health colleague Joseph Ladapo, MD, PhD. The goal was not to “convey victim blaming” nor to “stereotype all police officers,” said Dr. Ravenell, but to “start the conversation about what doctors’ responsibility is to help save the lives of all people.”

Deaths of people killed by law enforcement are not monitored comprehensively in the United States, and as a result there is a lack of accountability for preventing them, said Nancy Krieger, PhD, a professor of epidemiology at the Harvard T.H. Chan School of Public Health. For this reason, her team began in 2014 tracking law enforcement deaths using diagnoses codes in Vital Statistics data and speaking out on how to make these data more visible. “If we do not have data made accessible to groups organizing around data, problems fester and get worse,” she said.

Built around a public health prevention approach, the organization Cure Violence works across the country to diffuse violent situations before they happen. In the Bronx neighborhoods of Morrisania, Eastchester, Queensbridge, and the South Bronx, Cure Violence’s work has correlated with extended periods without shootings or homicides, said Shannon Cosgrove, MHA, director of health policy for the organization.

Shannon Cosgrove, MHA ,of Cure Violence; Nancy Krieger, PhD, of Harvard Chan School of Public Health; Joseph Ravenell, MD, of the Department of Population Health; and John Hockenberry of WNYC

Former CDC director on where to make a difference

Former CDC director Tom Frieden, MD, and Gbenga Ogedegbe, MD, of the Department of Population Health

In a wide-ranging plenary and question and answer session, Thomas Frieden, MD, MPH, former director of the Centers for Disease Control and Prevention, spoke about how health professionals can make a difference on health inequity. From tuberculosis to heart disease to opiate addiction to HIV, “addressing broader social context is crucially important” but as a health professional one needs to think not just about what “should” be done but “what can be done and figure out how to do it.”

“Changing the social context isn’t always an option and it’s never easy or clear, and it’s not either/or,” said Dr. Frieden in a question and answer session with Gbenga Ogedegbe, MD, MPH, professor in the Department of Population Health. “Just because we’re trying to improve prescribing for opiates doesn’t mean we shouldn't try to address racism, classism, or all of the other issues in this country.”

Improving housing and neighborhoods improves health

In the final panel, “Strengthening Urban Settings to Improve Wellbeing” speakers shared strategies that neighborhoods and housing authorities are working on to bring about health and other gains for economically struggling neighborhoods and spoke more about these approaches with moderator Chau Trinh-Shevrin, DrPH, associate professor and vice chair for research in the Department of Population Health.

Charles Branas, PhD of Columbia Mailman School of Public Health; Katherine O’Regan, PhD, of NYU Wagner; Rasmia Kirmani-Frye, of the New York City Housing Authority; and Chau Trinh-Shevrin, DrPH, of the Department of Population Health

Making improvements to the physical environment, such as refurbishing abandoned housing and greening vacant lots in cities like Philadelphia, Charlotte, North Carolina, and Flint, Michigan, are connected with reductions in residents’ stress, gun violence, and nuisance crimes and have a high return on investment, Charles Branas, PhD, chair of epidemiology at the Columbia University Mailman School of Public Health, has found in his research. The changes “are not large and luxury interventions in cities, not ‘destination amenities,’” like the High Line, that tend to serve wealthier populations, said Dr. Branas. “What we’re looking for are inexpensive, shifts in installations in neighborhoods that can be distributed throughout a city,” he said.

To reduce the high rate of avoidable hospital visits among its residents, the New York City Housing Authority (NYCHA) is working with the New York City Department of Health to connect them to preventive health services, improve their indoor environments, and encourage them to lead in health improvement efforts, such as an urban farm program built and maintained by young residents, said NYCHA’s director of public/private partnerships, Rasmia Kirmani-Frye, MS. “A safe, clean and healthy home is the right of every individual regardless of zip code,” she said.

Katherine O’Regan, PhD, former assistant secretary for policy development and research at the U.S. Department of Housing and Urban Development, (HUD) encouraged healthcare and public health professionals to partner with housing organizations and shared examples of where this is already happening, such as in senior and early childhood care. At HUD and public housing authorities across the country, there is a “recognition that affordable, stable, quality housing is at the foundation for a whole collection of other good outcomes—good health, educational outcomes, economic mobility,” said Dr. O’Regan.